Managing the waste of over processing in healthcare using accountability through utilization reviews and information technologies

Abstract

Hospital operating performance relies on the proper utilization of resources and procedures. Unfortunately, the waste of over processing through unnecessary healthcare can reduce patient flow and increase costs to patients and hospitals. This article examines two commonly used mechanisms for addressing over processing in healthcare: accountability (individual and cross-functional) through utilization reviews (critical evaluations of service decisions regarding the appropriate service at the right cost), and their interactions with healthcare information technology (HIT) infrastructure. Hierarchical regression analyses reveal insights into service flow (patient length of stay) and efficiency (operating cost per bed) using independent primary and secondary data from 250 U.S. hospitals. The analyses show contrasting results and tradeoffs. For utilization reviews, accountability focused on individuals is associated with lower cost per bed but longer length of stay, while results for cross-functional accountability are not significant. The interaction between individual accountability through utilization reviews and HIT infrastructure relates to incremental reductions in patient length of stay, suggesting a complementary relationship for managing hospital operating performance and over processing.